July 10, 2020 - CFS Unravelled

Fibromyalgia is a difficult disease to diagnose and treat. Currently, there is no established diagnostic test that can detect the condition in a patient. Most fibromyalgia symptoms may overlap with other symptoms or get misdiagnosed as another condition. A study from the Mayo Clinic suggests that many people with the condition often go undiagnosed7 - especially men with fibromyalgia.People including some doctors often think that fibromyalgia is a women’s disease and many people don’t know much about the occurrence and impact of fibromyalgia in men. We look at the medical research regarding gender differences in fibromyalgia and what additional challenges men with fibromyalgia can experience.Can Men Get Fibromyalgia?Historically it is generally believed that more women than men get fibromyalgia. Some people have suggested that the difference in symptoms of fibromyalgia in men changes the rate of diagnosis.In years gone past, it has been suggested that only 10% of fibromyalgia cases are men (so women are 9 times more likely to have fibromyalgia or there is a ratio of 9:1). However, more recent studies suggest that fibromyalgia is almost exclusively a women’s disorder is not supported by data in unbiased studies. 6Under-diagnosis in men with fibromyalgiaOne study looking at adults residing in London, Ontario found that 4.9% of women and 1.6% of men experience fibromyalgia suggesting a rate more like 3:1 .1 A study looking at the prevalence of fibromyalgia suggested that the rate may be more like 1:1 2.So the myth that fibromyalgia is a women’s disease may not just be due to diagnostic criteria used, but also due to men not identifying and under-reporting symptoms. 2 3 In fact one study found that 20 times more men reported fibromyalgia symptoms than had a diagnosis compared to 3 times for women.4What Are the Risks of Having Fibromyalgia in Men?Gender is a primary risk factor of fibromyalgia, but only one of them. Rheumatic conditions, such as lupus, also increase your chances of developing the condition. So does having a first-degree relative (whether male or female) with fibromyalgia.So why do men get fibromyalgia? What triggers the condition among them? Certain types of trauma (e.g., car accidents), viral infections, and emotional stress can trigger it. Men with mood disorders such as anxiety and depression are also at higher risk for fibromyalgia. In general, patients with systemic and chronic inflammation accompanied by a history of mood disorders and genetic links are most at risk of developing the condition.In rare cases, fibromyalgia in men strikes without warning. What are symptoms of fibromyalgia in men?The symptoms of fibromyalgia are generally well recognised and document, but are the symptoms for men different then they are for women.One research paper looked at 28 different studies and found that overall, men with fibromyalgia experience more stress and worse sleep whilst women complained more about pain related symptoms. 5How Fibromyalgia Affects MenChronic pain may be the condition’s primary symptoms of fibromyalgia in men, but the condition can sometimes come with additional complications. Apart from constant pain, patients with this condition experience difficulty in sleeping and chronic fatigue. Other common complaints of fibromyalgia include irritable bowel syndrome (IBS), headaches and restless legs syndrome. Difficulty in concentrating and memory problems also comes with the territory. The symptoms of fibromyalgia are not to be taken lightly since they can make getting out of bed impossible. Below is a list of fibromyalgia symptoms in men:Pins and needles sensationTenderness across the bodyNauseaSleep disordersStiffness in jointsMuscle spasmsDifficulty with balanceIncreased sensitivity to hot and coldAnger, irritability, and other mood disordersSome men also report amplified pain (hyperalgesia) specifically in the neck. This symptom has sent men who have delayed seeking treatment for years to their doctors. Sensitivity to loud sounds and light may also be present, especially if the patient is suffering from allodynia, which is a pain sensation triggered by the slightest touch, such as a hug, breeze, or a handshake. Symptoms are often intense when they appear, only to disappear completely for weeks or months at a time. Some men with the condition find their symptoms worsening due to changes to the weather or lack of sleep. Others consistently experience a set of constant symptoms.Besides the physical symptoms of fibromyalgia, men may also be affected differently mentally to women. One study noted that 1 in 10 respondents felt there was a stigma for fibromyalgia in men because it is widely seen as a condition that primarily affects women. 3 Men’s top fibromyalgia symptom reported was depression.Why the difference in how men and women are affected by fibromyalgia?Respondents in the above study indicated that the pressures of being the primary provider for the family was unfair and added to the impact of fibromyalgia on men as they stopped being able to engage in paid work. These societal roles to provide and protect the family can leave men feeling reduced self-worth, often leaving them feeling as failures.The study also found that men may be less likely to discuss symptoms of fibromyalgia than their women counterparts. Not only may this impede diagnosis, but it may also add to the mental health pressure that men with fibromyalgia experience.What Causes Fibromyalgia in Men?When a person is injured, their nerve signals travel from the problematic spot of the body through the spinal cord to their brain, which detects these pain signals. As the healing process starts, however, the pain gets better and eventually goes away.But if a person has fibromyalgia, they feel pain all over even if they are not injured or sick. According to some doctors, this could be a ‘glitch’ in the way the spinal cord or the brain handles pain signals. The ‘glitch’ occurs because a person has more cells that carry pain signals than usual.The trigger that causes fibromyalgia in men varies from one case to another. Many things could trigger the body’s pain signals to go awry. Also, different patients report different triggers of their condition. These causes include:Genes. Fibromyalgia seems to be an inherited condition. The parents may pass on the genes that make them more sensitive to pain.Gender. As mentioned, fibromyalgia is more common in females than in males. Doctors believe this could be related to the way men and women react to and feel pain, as well as how society expects each gender to respond to pain.Emotional or physical abuse. Children who suffered from abuse are more likely to develop fibromyalgia when they become adults. This happens because abuse changes the way the brain handles stress and pain.Post-traumatic stress disorder (PTSD). People experience PTSD after a terrible event such as a car crash, war, or rape. These events are also linked to patients with fibromyalgia.Lack of exercise. Fibromyalgia is common in people who aren’t physically active. Exercise can help alleviate the pain caused by fibromyalgia. Diagnosing Fibromyalgia in MenConflicting opinions from different researches on fibromyalgia syndrome in men further complicates diagnosis. Some researchers believe that men experience milder symptoms. At the same time, some reports insist men can experience more severe symptoms, such as lower quality of life and less ability to function.The first step in diagnosis is finding a doctor who can explore all sides of the patient’s condition. Doctors take a complete family and medical history to eliminate the possibility of other conditions. Apart from reviewing your symptoms, they will complete a thorough physical exam to determine tender points in the body. While this symptom is not a clear indicator of fibromyalgia, the tender points can provide more information during a diagnosis.Doctors often use the 2010 American College of Rheumatology diagnosis guidelines to create a better diagnosis. These new guidelines list the following as markers for fibromyalgia:Symptoms have persisted for at least 90 days Widespread pain index (WPI) is greater than or equal to sevenNo alternate disorder can explain the painAs part of the physical examination, the doctor must also run lab tests to uncover what the condition is not. Some tests that doctors do include:UrinalysisComplete blood countThyroid function testsVitamin D levelsErythrocyte sedimentation rateTreatment for Fibromyalgia in MenHealthcare professionals’ treatment for fibromyalgia in men in two ways: holistically and symptomatically. The goal of both is to ease the current symptoms while working towards a recovery plan. There is no cure for the condition, but it is possible to recovery either partially or fully. A partial recovery means easing the painful symptoms, and improve a person’s overall quality of life. A full recovery means being able to engage normally in life without flare ups.Common treatments include the following:Interventional treatments. Medications can treat fibromyalgia flare-ups in men. Currently, there are three approved medications:SavellaCymbaltaLyricaOff-label medications that can also be prescribed for fibromyalgia include:Muscle relaxantsCertain antidepressantsAnti-seizure medicationsNon-steroidal anti-inflammatory medications to soothe acute painAlternative treatments. The following treatments may help ease the stress and pain of fibromyalgia:Acupuncture. This traditional method of healing can help in restoring ease of movement and mobility.Float tanks. A single session of weightless treatment in float tanks can ease the pain of the condition.Biofeedback. Patients learn how to recognize, monitor, and control their body’s response to the pain. This treatment may change the way the body responds to stress over time.Gentle massage. A light massage maintains good circulation to ease the pain.Lifestyle changes. Making certain lifestyle changes is one of the best ways to prevent flare-ups. Getting a good night’s sleep is the first step. Regular exercise also promotes good sleep, as well as excellent mental health, which reduces the severity and risk of anxiety, depression and symptoms of PTSD.Eating a healthy diet helps you manage chronic pain. Add fruits, vegetables, and protein to your diet to keep your body healthy. Recovery from Fibromyalgia in MenEven though there is no single cure for fibromyalgia in men, both partial and full recoveries happen. You can listen to how other men recovered from fibromyalgia in the recovery stories and interviews.Understanding the dynamics of the illness and how you can partner more effectively with health care professionals and make lifestyle changes to support your recovery is key. You may find that an education program like ANS REWIRE can support you with your fibromyalgia recovery efforts.Citations1. White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. The Journal of Rheumatology. 1999 Jul;26(7):1570-1576. retrieved from https://europepmc.org/article/med/10405947 BACK ⤣2. Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int. 2017;37(9):1527-1539. doi:10.1007/s00296-017-3725-2 retrieved from https://pubmed.ncbi.nlm.nih.gov/28447207/ BACK ⤣3. Muraleetharan D, Fadich A, Stephenson C, Garney W. Understanding the Impact of Fibromyalgia on Men: Findings From a Nationwide Survey. Am J Mens Health. 2018;12(4):952-960. doi:10.1177/1557988317753242 retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131475/ BACK ⤣4. Vincent, A., Lahr, B.D., Wolfe, F., Clauw, D.J., Whipple, M.O., Oh, T.H., Barton, D.L. and St. Sauver, J. (2013), Prevalence of Fibromyalgia: A Population‐Based Study in Olmsted County, Minnesota, Utilizing the Rochester Epidemiology Project. Arthritis Care Res, 65: 786-792. doi:10.1002/acr.21896 retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/acr.21896 BACK ⤣5. Úbeda-D’Ocasar, Edurne & Gallego-Sendarrubias, Gracia & Guodemar-Pérez, Jesus & Hervás-Pérez, Juan. (2020). Differences Between Men and Women with Fibromyalgia. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 23. 10.1055/a-1089-8152. retrieved from https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1089-8152 BACK ⤣6. Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W (2018) Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias. PLOS ONE 13(9): e0203755. https://doi.org/10.1371/journal.pone.0203755 retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755#sec017 BACK ⤣7. Men with Fibromyalgia Often Go Undiagnosed, Mayo Clinic Study Suggests. https://newsnetwork.mayoclinic.org/. https://newsnetwork.mayoclinic.org/discussion/men-with-fibromyalgia-often-go-undiagnosed-mayo-clinic-study-suggests/. Published 2012. Accessed August 13, 2020. BACK ⤣

Fibromyalgia In Men – Effects Beyond the Symptoms